Healthcare Provider Details

I. General information

NPI: 1730752296
Provider Name (Legal Business Name): FLORIDA KIDNEY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 TAMIAMI TRL S
VENICE FL
34285-5557
US

IV. Provider business mailing address

1515 TAMIAMI TRL S
VENICE FL
34285-5557
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-8720
  • Fax: 855-793-3651
Mailing address:
  • Phone: 941-505-8720
  • Fax: 855-793-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA ELENA RIVERA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-610-6100